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DEATH
CERTIFICATE
OTIS GAYHEART
Date: 29 July 1950
Cert: 17095
Place of Death: County: Perry City or Town:
Hazard
Length of stay (in this place): (blank)
Name of Hospital or Institution: (blank)
Usual Residence of Deceased: State: Ky. County:
Perry
City or Town: Jeff Street Address: (blank)
Full Name: Otis GAYHEART
Date of Death: 29 July 1950
Sex, Color or Race, Marital Status: Male, White, Married
Date of Birth: 15 November 1913
Age: 36 years
Usual Occupation: Miner
Kind of Industry or business: Coal
Birthplace: Knott Co., Ky.
Father's Name: Cap GAYHEART
Mother's Maiden Name: Alice SMITH
Was deceased ever in armed forces: (blank)
Social Security No.: 404-16-311?
Informant: Cap GAYHEART
Disease or condition directly leading to death: Car
wreck
Interval between onset and death: (blank)
Due to: Skull Fracture
Other significant conditions: (blank)
Date of Operation: (blank)
Major findings of operation: (blank)
Autopsy: No
Accident, suicide, or homicide: Accident
Place of injury: (blank)
City or Town, County, State: Perry County, Ky.
Time of Injury: 29 July 1950
Injury occurred at work: (blank)
How did injury occur: (illegible)
I hereby certify that I attended deceased from 29 July 1950 to
29 July 1950, that I last saw the deceased alive on 29 July
1950, and
that death occurred at (blank), from the causes and on the
date stated above.
Date signed: 07 August 1950
Address: Hazard, Ky.
Signature: Hannibal Shockey, Coroner
Burial, Cremation or Removal: Burial
Date: 02 August 1950
Name of Cemetery or Crematory: Gayheart
Location: Knott Ky.
Date received by local registrar: 07 August 1950
Registrar's Signature: Georgia Pendleton
Funeral director & address: Johnson Funeral Home
Transcribed by Debbie Tamborski, 15 July 2010 |
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